Resident-To-Resident Aggression in Nursing Homes, Essay Example

One of the crucial and practical nursing skills is the ability to conduct individual critical analysis. Kong et al. (2014) indicate that critical analysis enables nursing students to evaluate the shreds of evidence to inform their decision-making process. Particularly, it is essential to possess critical skills to analyze key nursing competencies that embrace fundamental behavioral attributes and mastery of pertinent practical skills.

In this reflection portfolio, I have chosen to analyze the competency of “collaborative practice, leadership, and teamwork” in clinical settings. I believe that this a key area in nursing that ensures patients receive quality care. After an analysis of my strengths and weaknesses, I feel that I lack ample leadership skills, and I may not have done enough to meet the level required at the point of registration. That is because, in a couple of times, I felt that delegating duties to others, I was overburdening them. Besides, I was always worried that health care assistants I delegated work to, might not do it to the standard I want, and I am constantly looking over their shoulders to make sure they do everything perfect and on time. At the same time, I feel that I should be encouraging and giving them the confidence to work on their own. Before I register, I need a master’s way to balance my leadership skills and to ensure I instill confidence in others.

Reflection on Competency Areas

In this section, I will discuss key competency areas in collaborative practice, leadership, and teamwork. I will evaluate knowledge and skills relating to each sub-competence and relate my practice with nursing and management theories and find ways that I can improve.

• Collaborates in a way that values the roles and responsibilities of others in the team; respects their skills, experience, and contributions; interacts appropriately and confidently
• Actively consults and explores solutions and ideas with members of the multidisciplinary team including patients/service users, families and carers to enhance care
• Can respond to planned and unplanned situations, managing self and others in a flexible and adaptable way

The above sub-domains are related to leadership and teamwork. They are used to show a nurse’s ability to communicate effectively through collaborative practice. The World Health Organization (WHO) indicate that collaborative practice when healthcare professionals from diverse backgrounds work together with patients and their families to provide and deliver comprehensive and highest quality health services all health settings. This means that nurses are part of the multidisciplinary team (health professions from different disciplines) who work together to provide specific services to patients. In mental health facilities, for instance, nurses are required to work collaboratively to respond to contingency events that can occur due to the unforeseen nature of mentally ill patients.

Bonifas (2015) suggests that nurses should work collaboratively to plan and provide support, medical, and nursing care to individuals with mental issues. Individually, I can work with other health workers to observe and assess mentally ill patients administer therapy and observe whether treatment is working positively. That way, I can recommend an array of activities and programs for patients to participate in. Besides, I can educate and liaise with patients’ families to help them participate in behavior medication programs. I did recognize the importance of working with MDT members to ensure diagnosis, physical examinations, and clinic follow-up are completed. Thus, I have demonstrated the ability to work with health professions to deliver patient-centered care.

Daly and Carnwell (2013) denote that collaboration should foster MDT relationships with patients and their families. While working in the clinic, I delegated duties to other practitioners to ensure optimal patient care. Although I felt as if I was overburdening them, it was necessary to delegate duties, especially in areas outside my scope of practice. Members who performed these duties did not complain and were happy to help. Furthermore, I had a good relationship with my mentor. Throughout my practice, we never had disagreements or arguments. I paid attention to every detail of his instruction. I can confidently say that his guidance was utterly beneficial to my practice development.

The domain of leadership and collaboration is related to my ability to work with other health professionals, develop relationships and networks, and work collaboratively to deliver patient-centered care. By its very nature, the nursing profession is amongst the leadership role in a healthcare setting. Across the health setting continuum, nurses are looked at as leaders no matter the role one plays or practice setting – they should act as leaders. As a nursing student, I have been taught to lead others, be responsible and accountable for patient outcomes, and oversee care teams.

Looking at my reflection, I need to evaluate myself and use theoretical underpinnings to find ways that I can use to improve my skills in this competency.  For instance, a shared leadership model outlines values that a nurse should possess to provide care services through others (MDTs). In nursing, the shared leadership model involves maximizing MDT by empowering and giving them opportunities to take leadership positions and undertake duties in their areas of expertise. In relation to the argument of this model, I did delegate duties to healthcare assistants and allowed them to make decisions that influence their work, professional development, work environment, and self-fulfillment. Walker (2010) claims that shared leadership at the unit level strengthens continuous learning and improve relationships between MDT members. Such practice creates a strong foundation where nurses can establish new relationships with each other and with facility management.

The situational theory of leadership is another theoretical underpinning that informs better leadership practice in health settings. Lynch (2015) suggests that leaders can adopt different leadership styles in accordance with the situations they face and the development of MDTs. Under this model, a leader should adapt to the needs of the team and set a beneficial balance in the unit or throughout the facility. The model is also applicable when dealing with patients. As a leader, I recognize the importance of adapting to different situations, especially when dealing and managing patients. Overall, I have demonstrated I can work with MDTs to provide effective care services to the patients. I have also shown I can work with others through collaborative practices in planned and unplanned situations.

Overall, leadership theories indicate that RMN’s must possess the ability to work with other health professions, develop teamwork, networks, and relationships at the workplace. In this regard, I have adequately worked with other professionals in health services. For instance, at the health facilities and fieldwork, I collectively worked with several other health professionals such as addiction counselors, internees, internists, registered nurses, and social workers to deliver management objectives, including patient-centered services. I have also learned the importance of working collectively with other professionals in the mental health department to ensure there is adequate assessments, health scans, diagnosis, treatments, and follows are completed. In critical competence related to episodes of care management, I have demonstrated the ability to work with patient health units to deliver appropriate health services.

The sub-domain (2) calls for nurses to work in teams by consulting and exploring solutions and ideas with MDT, including service users, families, and cares to improve the level of care rendered. Everyone possesses a different pattern of behavior and traits. When nurses come together and work as a team, they can facilitate the delivery of patient-centered care. Belbin Team Role theory is one of the most recognized theories that inform nurses on their roles in teamwork. According to Belbin, for a team to be high performing, it will require members with the following traits:

• Resource investigator – someone who can use curiosity to find ideas and bring to the team
• Coordinator – members who can focus on the team’s goals, draw other members and delegate duties appropriately

Teamworker – someone who can help the team to gel, use versatility to identify required work, and can finish it on behalf of team members.

• Plant – a team that needs a member who is highly creative to solve problems in unconventional ways.
• Specialist – a team also needs an individual who can bring in-depth knowledge in key areas to the team
• Monitor evaluator – the team needs someone who can offer logical eye, make impartial decisions where needed and weigh upon available options.
• Shaper – a team also needs members who can offer the necessary drive to keep the team moving and ensure members do not lose focus on their objectives.
• Complete finisher – team need members who can polish and scrutinize work to eliminate errors and ensure overall work is up to the standards of quality control

Implementer – a team also needs members who can provide a workable plan and execute it efficiently.

In nursing, to have a high performing team, you do not need to have members with all the nine roles; 3 to 5 members with the above trait can make the team effective to deliver the highest standard of care that meets quality controls.

• Inspires confidence in other members of the team, adopting the leadership role when appropriate
• Takes responsibility for coordinating and delegating care, preparing, supporting and supervising those to whom care has been delegated
• Facilitates others, for example, nursing students, to develop their competence and confidence, sharing your skills, knowledge, and experience for the benefit of people receiving care.

The above sub-domains are associated with leadership and mentorship. Meanwhile, Registered Mental Health Nurses (RMNs) are tasked with the role of coordinating care for all patients. RMNs are expected to guide and reinforce team members while concurrently mentoring nursing students (Sweeney et al., 2016). That way, RMNs can guarantee that each team is not only goal-oriented, but they also work towards collective visions. Different aspects of modern healthcare are being adopted to promote caregiving and wellness of the workforce. For example, delegation is broadly utilized in clinical settings to facilitate teamwork and ensure that all tasks related to care are implemented well. The approach also curbs the issue of burnout, which affects the performance of individual team players. Currently, the rates of burnout among medical professionals have exceeded 40 percent (McCrory, 2016). Therefore, healthcare institutions need immediate access to relevant tools to fight the professional and personal dysfunction that hurts them and their work.

Different styles of leadership aim to attain specific goals. For instance, transformational leadership perceives the act of leading as an initiative that transforms and develops individuals (Caillier, 2015). Therefore, a transformational leader possesses a broad range of attributes, including a focus on ethics, values, principles, and also the ability to set long-term objectives for a team (Wang, Kim, & Lee, 2016). The individuals also embrace motivation as a critical factor in getting things done quickly and efficiently. Likewise, a transformational leader must be both charismatic and visionary (Caillier, 2015). It is his or her responsibility to energize and excite people to boost their performances. Their elevated level of motivation is imperative in influencing, as well as developing team members.

Furthermore, a transactional leadership style is mainly focused on task orientation, as well as completion. The leader develops agreements of the underlying expectations, but with a significant focus on both rewards and punishment (Holten & Brenner, 2015). For instance, the NHS is based on strict procedures and policies to guarantee the safety and efficiency of the delivered patient care. In this regard, as an RMN, I have a legal responsibility to ensure that all delegated works are pursued sufficiently. Thus, healthcare assistants must recognize the importance of what I expect them to do and the potential consequences on caregiving (Royal College of Nursing, 2017)

Meanwhile, I always adopt the transformational leadership style as it allows me to apply my energy, as well as enthusiasm in knowledge sharing and while promoting patient care. Taking a transactional leadership initiative is also essential, particularly in a healthcare setting, when delegating duties and responsibilities. It ensures that team members understand their roles and the benefits, as well as risks that are related to patient care. I have not practiced the transactional leadership style yet, but I aim to adopt it somewhere in the future.

Sub-domain (#5) is related to taking responsibilities and delegating duties to others in health care settings. During my time at the clinic, there are certain instances where I felt uneasy being the leader and ended up delegating my duties to others. In such cases, I feel like I am overburdening others with my tasks by asking them to perform my duties. Thus, I feel that it would be better if I undertook those duties myself and execute them even quicker. However, Ponte et al. (2010) suggest that nurses should be able to communicate effectively with other relevant health professionals regarding the patient’s treatment plan and understand the importance of engaging and assigning team members in the delivery of patient-centered healthcare services. I have delegated duties to others and instilled important confidence and encouraged them to work without direct supervision. That way, I have demonstrated four basic styles in situational leadership – to direct, coach, support, and delegate, in a working relationship combination.

• Participates in team decision making. Can assertively challenge contributions where necessary through discussions and informed debate, respecting others’ views and opinions, and behaving professionally.

The above sub-domain upholds respect and assertiveness as the primary skill base. It is always also the responsibility of an RMN to advocate for patients. The approach enables them to feel courageous to oppose some decisions that they feel are inappropriate to their care. Besides, among the 6C’s of the nursing practice, courage is at the top. In essence, the support and recommendation of RMNs work well in favor of a patient when his or her choice is terminated by rulings that are implemented under the legislation, such as the Mental Capacity Act (2005) and Mental Health Act (1983). RMNs intervene to ensure the patient’s interests are upheld.

According to the trait theories, personal attributes, such as assertiveness, can make a competent leader. Communication is a crucial factor in leadership; hence, assertiveness is necessary for any person aspiring to lead successfully. The approach allows individuals to embrace self-worth, thus making them eager to participate in discussions to express not only their facts and opinions but also uphold respect for others and their viewpoints. RMNs understand the importance of patients in the establishment of adequate care. Therefore, the value and respect their perspectives. Over time, I have seen many people, mostly in higher ranks than mine, struggle with recognizing the opinions of others. Therefore, I will often strive to accommodate patients’ wishes in everything I do as it promotes care and helps individuals to develop a sense of belonging.

Challenges to be Resolved

The success of mental health nursing depends on several factors, including leadership, teamwork, and collaborative practice. The main problems identified relate to task delegation and the assertiveness challenging of decisions.

Assertiveness is a critical skill in nursing practice. However, according to Timmons, Evans, & Nair (2016), nurses tend to be more submissive helpers than assertive workers. Different studies have reported reduced levels of assertiveness are reported among nurses across the globe (Av?ar & Alkaya, 2017; Speed, Goldstein & Goldfried, 2018; Erbay & Akçay, 2013). Low self-esteem/confidence, anger, negative thinking, stressful life events, and are possible reduced levels of assertiveness. In health settings, low assertiveness can affect how nurses interact with each other and MDTs. Thus, it is important for nurses to realize they have and responsibility towards patient care and should be positive, confident, and bold on their actions. Taylor et al. (2005) indicate that nurses can find corrective solutions that are suitable for all people and enhance changes in meeting needs for others. Warland, McKellar & Diaz (2014) suggest nurses should effectively express their opinions, needs, and right in ways that are respectful of others.

The ability to delegate tasks is also imperative in mental health nursing. However, challenges, such as the fear of conflict, hinder certain team members from engaging with the approach (Hasson, McKenna, and Keeney, 2013). Registered nurses claim that dispute, which is facilitated by differences in personality, work ethic, age, and role conflict, is the main barrier to work delegation. Nevertheless, the problem can be addressed through effective communication, well-managed teamwork and practices, sharing of crucial information, and preparing individual teams for the workload (Potter, Deshields, & Kuhrik, 2010). It is also crucial for nurses to understand what is expected of them, as well as what always needs to be pursued (Potter et al., 2010).

Conclusion

Upon pursuing a gap evaluation proforma in the area of management and leadership, I identified my skill potential by fusing my opinion with evidence from several reliable sources. For instance, I learned that I was incompetent in areas such as leadership, teamwork, and collaborative initiative. However, I have ventured into theoretical interventions regarding the skills necessary for the underlying potentials. Therefore, I have acquired the full perception of several leadership principles, which can help me to promote the required knowledge to meet the underlying standard.

Action Plan

My goal is to attain the standard necessary for registration related to the underlying competency. In this regard, I shall establish SMART objectives for my final placement. The purposes will allow me to reveal my attainment of this potential. Therefore, I have selected a set of three targets for my arrangement, which will be elaborated regarding the above critical evaluation.

• 1^st goal: To recognize the dietician for the underlying team of eating disorders, as well as establish a care strategy for a patient with eating disorder on my eventual placement – This objective is particular to the needs and demands of a patient suffering from an eating disorder. Regarding the shared leadership framework, this objective will allow me to work closely with leaders in their field with the potential to offer excellent care based on standard expertise.
• 2^nd Goal – To initiate a change, and elaborate to team members the merits, as well as risks associated with task delegation – This objective is founded on transactional leadership style, mainly when tasks are directed based on punishment and rewards. Through elaborating the risks, as well as benefits to the patient, I will venture on the rationale of colleagues, which may encourage. The measure of the goal will be achieved through monitoring the completion of tasks.
• 3^rd Goal: To scrutinize the decisions being made during the routine ward rounds and uphold the perspective of patients regardless of the underlying differences. This objective seeks to reveal my assertiveness when running ward rounds. I will incorporate my duty to my patients and support their viewpoints in everything that I do. Van Quaquebeke & Eckloff (2010) that the best way to challenge colleagues’ decisions is to communicate openly, privately, and honestly. Whenever possible, I will directly communicate with my colleague at the ward units and agree on the best corrective action. Besides, nursing is a team-oriented profession; nurses should collaborate and work with IDT and MDT to improve patient outcomes.

References

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Bonifas, R. P., 2015. Resident-to-resident aggression in nursing homes: Social worker involvement and collaboration with nursing colleagues. Health & Social Work, 40(3), e101-e109.

Caillier, J. G. (2015). Transformational leadership and whistle-blowing attitudes: Is this relationship mediated by organizational commitment and public service motivation?. The American Review of Public Administration, 45(4), 458-475.

Daly, W. M., & Cornwell, R., 2003. Nursing roles and levels of practice: a framework for differentiating between elementary, specialist, and advancing nursing practice. Journal of Clinical Nursing, 12(2), 158–167.

Erbay, E., & Akçay, S. (2013). Assertiveness skill of social work students: A case of Turkey. Academic Research International, 4(2), 316.

Hasson, F., McKenna, H.P., and Keeney, S. (2013). Delegating and supervising unregistered professionals: The student nurse experience. Nurse Education Today, 33(3), 229-235.

Holten, A. L., & Brenner, S. O. (2015). Leadership style and the process of organizational change. Leadership & Organization Development Journal, 36(1), 2-16.

https://www.rcn.org.uk/professional-development/accountability-and-delegation

Kong, L. N., Qin, B., Zhou, Y. Q., Mou, S. Y., & Gao, H. M., 2014. The effectiveness of problem-based learning on the development of nursing students’ critical thinking: A systematic review and meta-analysis. International Journal of nursing studies, 51(3), 458-469.

Lynch, B. (2015). Partnering for performance in situational leadership: a person-centered leadership approach. International Practice Development Journal, 5.

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